Immunity

Severe ADR's of vaccines

-Febrile illness -Seizures -Anaphylaxis -Somnolence

Cons of passive immunity

-Immunity is short term. -Gone when the immunoglobulin is gone. -Not as effective as actively immunizing

Tetanus-diphtheria is recommended for all pregnant women at weeks...

0, 4, and 6-9 months

Pneumovax 23

A polysaccharide pneumococcal conjugate vaccine that incorporates more antigens from different strains of pneumococci so immunity to more strains of pneumo is achieved.

Prevnar

A protein conjugated vaccine for pneumococcal used in Children under 2. Less antigens but still protective.

Pneumococcal Vaccine

a conjugate vaccine

Fractional vaccine can be interchanged with...

conjugate vaccine

Seroconversion

development of antibodies in the blood that are measured after vaccination to see if immune. *not all vaccines have antibodies to measure

If clean minor wound in a patient with unknown tetanus immunization status then... Had series >10 years ago?

give complete series. give a booster.

If tetanus immunization status is unknown when a patient gets a tetanus prone wound...

give immunoglobulin and complete series of vaccines. -toxin is produced in 5 days and primary immune response takes 7.

Common vaccines used in passive immunization

hep A -varicella -tetanus -rhogam

Most viral vaccines invoke the use of...

live virus that has been chemically changed to decrease its virulence (attenuated) *The immune response is more like having the disease.

Toxoid vaccine

prevent diseases caused by bacteria that cause toxins in the body.

Give shots for active and passive immunity at...

separate sites on the body.

If giving immunoglobulin to a patient, the provider also needs to...

vaccinate because passive immunity is not long lasting.

In the process of making toxoid vaccines, the toxins are...

weakened so they cannot cause illness. (weakened toxins are called toxoids)

Examples of active and passive immunization

-Infants born to mothers with Hep B get both vaccine and immunoglobulin at birth. Greatly reduces maternal transmission. -Rabies vaccine receive active and passive vaccines due to severity of illness.

Examples of live attenuated vaccines

-Intranasal influenza -Varicella -Smallpox -Measles, mumps, rubella -Varicella vaccine -Varicella-zoster vaccine

Vaccines not contraindicated in...

-Mild to moderate local rxn -Mild acute illness -concurrent antibiotic use -Premature babies -Family hx adverse events -Diarrhea -Breast Feeding

Con of inactivated vaccines

-Often need higher doses than live vaccines -Need multiple doses

Benefits of live attenuated vaccines

-Superior response and typically doesn't require multiple doses -Often only need one dose (maybe 2) for lifelong immunity

Con of attenuated vaccine

-Virus can revert to a more pathologic form and cause disease. -Tend to have higher rates of adverse fx.

What are killed/inactivated vaccines prepared from?

-Whole bacteria/virus or a fractional antigenic component of one.

3 Vaccine types

1. Live attenuated vaccines 2. Killed, inactivated vaccines 3. Toxoids

Examples of killed vaccines

1. Tetanus, Diptheria 2. Tetanus, Diptheria, Pertusis 3. Human Papilloma Virus 4. Influenza 5. Pneumococcal 6.Hep A 7. Hep B 8. Hep A/B 9.Meningococcal

Children <_____ years old don't develop an immune response because their immune systems are too immature.

2 years old

Tetanus-diphtheria-pertussus recommended at ___________ weeks gestation if patient is unimmunized

20

Original tetanus series is ______ vaccines.

4

What is the concern of giving active and passive immunity at the same time?

Antigen in vaccine may bind to antibody in passive immunity decreasing the immune response.

Conjugate vaccines

Antigens covered with outer coating of sugar-like substances called polysaccharides.

Vaccines typically contain...

An agent that resembles a disease-causing microorganism.

National vaccine injury compensation act

Established to compensate those with an injury due to vaccines or those with a potential injury due to vaccines

How are specific IgG prepared?

By exposing humans or animals to the disease and then harvesting the antibodies they make in response.

How is passive immunity provided?

By giving preformed IgG antibodies specific for the disease state that is trying to be prevented.

Pros of inactivated vaccines

Can't cause disease or be contagious

How are antibodies created in active immunization?

Created by recipient and are stored permanently. -Done with vaccines -Usually a series of injections or exposures over a period of time.

MMR and influenza vaccine contain...

Egg proteins

When to use passive immunization

For a rapid response post exposure. -Use when a patient might get the disease before the vaccine would work.

If tetanus prone wound and patient had full vaccine series >5 years ago...

Give a booster vaccine

ADRs of vaccine

Inflammation at site of injection -malaise -fever -chills -HA, myalgias

FluBlok

Influenza vaccine that is egg free.

Vaccination gives ______________ lasting immunity than giving antibodies.

Longer

Inactivated poliovirus vaccine, MMR, and varicella contain ___________.

Neomycin. May cause anaphylaxis.

Who should not get Live attenuated vaccines?

Patients that cannot tolerate the possibility of getting the disease. -Immunocompromised -Pregnant -Virus can be shed so anyone with immunocompromised family member should also not get live vaccine.

What are fractional vaccines made from?

Protein or polysaccharide based.

Examples of toxoid vaccines

Tetanus and diphtheria toxoids

What is wrong with a shorter interval in vaccine schedules?

There might not be time for previous boost of memory. So less effective if given earlier.

Vaccines often made from...

Weakened or killed forms of the microbe, its toxins, or one of the surface proteins that stimulates the immune system.

How is passive immunity induced artificially?

When high levels of human (or horse) antibodies specific for a pathogen or toxin are transferred to non-immune individuals.

When does passive immunity occur naturally?

When maternal antibodies are transferred to the fetus via placenta or to the infant during breastfeeding

Pros of passive immunization

Works faster than active and protects during during incubation period. *Give when not enough time for vaccine to work before disease starts

How long does human immunoglobulin last?

about 3 weeks

NVIC act requires...

all events requiring medical attention to be reported within 30 days of a vaccination. *Don't necessarily need to believe injury was due to vaccine to report it. Just temporal relationship

often toxoids are combined with...

aluminum to prolong absorption. this prolongs exposure to the immune system and increases the immune response.

If tetanus prone wound and patient had full vaccine series <5 years ago...

no further action is needed.

Without polysaccharid covering, conjugate vaccines can...

stimulate a T helper response on their own

Passive immunity are used to counteract...

the fx of a toxin

Active immunization

the induction of immunity after exposure to an antigen.

Passive immunity

the transfer of active humoral immunity in the form of ready made antibodies from one individual to another.

Passive immunization is used when...

there is a high risk of infection and insufficient time for the body to develop its own immune response. Or to reduce the symptoms of ongoing or immunosuppressive disease.

Conjugate vaccines are effective for bacteria with a polysaccharide coating because...

they are made with a protein attached to the polysaccharide which can illicit a T-cell response